Hi NAM,
I wish there was some way I could convey to you how sincerely your situation touches my heart. I know your story well.... I've seen it too many times. The fact may be that you've had too much dentistry in the upper anterior of your mouth...... meaning the natural contour and integrity of the bone and gum tissue may at this point be compromised to the point that further gum and/or bone reduction could cause you to lose your teeth. This is the major concern that I have bases on the story that you have shared with us here.
I have copied and pasted some of your post, it is in the << brackets>>. My reply will be in CAPS.
<<Yes, all these Drs were very much aware of my medical and dental histories. I made it clear up front, esp since I have found an understandable gen reluctance to wk w/diabetics and compromised health issues>>. DENTISTS WOULD NOT BE RELUCTANT TO WORK WITH DIABETICS OR ANY OTHER COMPROMISED PATIENTS IF THEY HAD MEDICAL TRAINING. BUT DENTISTS ARE TAUGHT TO BE TOOTH CARPENTERS, NOT DOCTORS. UNLESS THEY EDUCATE THEMSELVES IN MEDICINE AFTER DENTAL SCHOOL, THEY UNFORTUNATELY KNOW LITTLE TO NOTHING ABOUT HEALTH ISSUES. MANY OF THEM DON'T THINK ABOUT THE CONSEQUENCES AND THEY JUST TREAT THESE PATIENTS LIKE ANYONE ELSE NOT TAKING INTO CONSIDERATION THAT THE TREATMENT OUTCOME MAY BE COMPROMISED. SOME DENTISTS ARE WISE ENOUGH TO REALIZE THAT THEIR LACK OF KNOWLEDGE ABOUT MEDICAL PROBLEMS SHOULD MAKE THEM RECONSIDER TAKING ON A PATIENT WHO FOR INSTANCE IS AN UNCONTROLLED DIABETIC.
Is this lack of knowledge fair to the public?? Absolutely not! Everyone has a right to proper dental care but how does someone in your shoes know where to obtain that? As you well know......... 10 different dentists looking at the same issue = 10 different opinions. How can that be????? I'll be damned if I know.
<<There was some disc bt Dr H and her tech re whether the material found was actually cords. They disagreed; Dr H said cords while the tech thot stitches. The areas where the material was left were 8+10. #8 was by far the worst for inflammation.>> IT IS POSSIBLE THAT THEY FOUND REMNANTS OF CORD UNDER THE GUM LINE SIMILAR TO TINY FIBERS. BUT NOT THE ACTUAL WHOLE PIECE OF CORD THAT WAS USED. SUTURES THAT ARE NOT DISSOLVABLE WILL GENERALLY DISINTEGRATE OVER A SHORT PERIOD OF TIME. UNLESS SOMETHING IN YOUR SALIVA PREVENTED THAT FROM OCCURING..... I GUESS ANYTHING IS POSSIBLE. THE ISSUE IS WHATEVER IT WAS, DID NOT BELONG THERE AND ITS PRESENCE INDICATES POOR DENTISTRY.
***The "cords" or whatever were quite long for the spaces involved. Absolutely poor dentistry!! Even Dr H was upset at that. If they were cords, they were placed by Dr. R's ofc. If they were stitches, it happened w/ Dr. G's surgical ging which included stitches, done 8/08 and discovered 11/08. Stitches were removed 9/08 by Dr G's tech, perhaps not completely. May never know.
<<There was no infectn per Dr H. She felt "provisional" (low fitting pre temp crowns) nec to reduce the severe inflammn in bt her 2 gingivectomies. She would not really elaborate on why she felt the 1st ging was nec other than "baby steps" to "just heal" the "train wreck" due to prev repeat trauma.>> THE LOW FITTING PROVISIONALS WERE PLACED TO ENCOURAGE THE GUM TISSUE TO HEAL WITHOUT ANYTHING IRRITATING IT. THESE TEMPS SHOULD ONLY BE WORN FOR A SHORT TIME BECAUSE THERE IS USUALLY SOME ROOT EXPOSURE NEAR THE GUMLINE THAT IS NOW VULNERABLE TO DECAY OR INFECTION. THERE ARE TIMES THAT THE GUM TISSUE NEEDS TO BE "ROUGHED UP" FOR LACK OF A BETTER TERM TO ENCOURAGE THE IMMUNE SYSTEM TO COME TO THE RESCUE AND HEAL IT FROM A PREVIOUS INJURY OR TRAUMA.
***They were worn for 6 wks for "healing," then repeat ging on 7+8, w/temp crowns then placed.
<<She had refused to rewk the crown for #9 herself, insisting another ging was instead nec when this crown was too pointed and the others were not. The gum height was not too high then. It now is. I elected not to cont w/her inc reasons previously discussed.>> THIS SOUNDS TO ME LIKE SHE FELT THE CROWN ON #9 WAS NOT FITTING PROPERLY AND TO TRY AND ADJUST IT WOULD RUIN THE INTEGRITY OF THE CROWN. THE SECOND GINGIVECTOMY OBVIOUSLY HEIGHTENED THE GUM TISSUE TO MUCH.
***She said requested "30 second" adjustmt to #9 might show the metal. When I asked to wear the temp longer to possibly allow the gumline relax more, she said it would not change the pointed shape of the tooth. Conversely, she also said the gum line was "done" that way. The repeat ging was to widen the area, not heighten it, but that was the result (Dr. T was right there).
<<I am definitely not :-( wanting to have more surgery or bone reductn. What I had initially described in my 1st post was finding a qualified DDS to reduce crown #9 @ gum line to achieve a more balanced look for the 2 teeth in front. That's my immediate goal while the crowns are still relatively new. Do you feel this is poss?>> I PERSONALLY FEEL THAT THE HEIGHT OF THE GUM LINE ON #9 IS NOT GOING TO CHANGE FOR THE BETTER IRRELEVANT OF WHAT IS DONE TO IT. COULD THE CROWN LOOK ESTHETICALLY BETTER? WITHOUT SEEING WHAT IT LOOKS LIKE, I REALLY CAN NOT COMMENT ON THAT.
<<While the initial goal was for 6 front teeth tb balanced, I have given up on that. Any bridgewk I am considering is to replace old bridges while I still have insurance.>> SOME THINGS THAT COME TO MIND WITH YOUR CROWNS AND BRIDGEWORK ....... ARE THEY PORCELAIN FUSED TO METAL? IF SO, IS THE METAL A HIGH NOBLE OR JUST A MIXTURE OF LESS NOBLE METALS? DO YOU HAVE ANY ALLERGIES OR SENSITIVITIES TO METAL IN JEWLERY THAT YOU KNOW OF? FREQUENTLY, PEOPLE ARE SENSITIVE TO THE MATERIALS/METALS THAT ARE USED IN DENTISTRY AND THEY CAUSE A NEGATIVE REACTION IN THE GUM TISSUE LIKE CHRONIC IRRITATION, INFLAMMATION OR RECESSION WHERE THE GUM TISSUE ACTUALLY PULLS AWAY FROM THE OFFENDING MATERIAL OR METAL. HAS ANY OF THAT EVER BEEN DISCUSSED WITH YOU? THERE ARE NON METAL, PORCELAIN TYPE MATERIALS THAT ARE CONSIDERED BIOCOMPATIBLE THAT ARE BETTER TOLERATED BY MOST PEOPLE. CROWNS, BRIDGES, AND PARTIAL DENTURES CAN BE MADE FROM THESE MATERIALS AND THEY LOOK GREAT AND WEAR TERRIFIC.
***Dr T wants all non metal; says he hasn't used PFM in 10 yrs. The bridge w/ #11 inclusive is PFM. That's the partial reasoning used behind Dr. H's choice of PFM for crowns, and being "conservative."
***I don't know the quality of metal used in either treatment.
***No, the option of porcelain was not discussed w/me by any DDS until Dr. T, yesterday.
*** PS:
***I now recall Dr. R did try a "higher quality" crown material in an effort to make them work; it did not. Subsequently the need for bone reduction arose instead.
***Otherwise, the option of a higher quality crown was not discussed except for Dr R's sales staff, and for reasons unrelated to health.
***I am unaware of an allergy to metal; my skin is sensitive however.
***Perhaps w/my prev trouble w/ bonding, I should be careful w/that?
<<One would be to replace a bridge that inc #11 in lieu of a gum graft which Dr G has offered to redo in order to fix his error during his ging. Because of the error, #11 now shows the tooth underneath the crown beginning that bridge. Quite honestly, not only do I not want more surgery, I'm not sure he can really do it and am apprehensive abt further error.>> SO DR G REMOVED TOO MUCH TISSUE IN DOING THE GINGIVECTOMY ON #11 SITE. IS THERE ANY WAY HE COULD PLACE A COMPOSITE MATERIAL AT THE RECESSION SITE INSTEAD OF REDOING THE ENTIRE BRIDGE?
***Yes, he removed some extra tissue from #11 as the access tooth to #10's ging. He is an MD as well as a DDS, but he "doesn't do" anything else besides surgery.
Different DDSs have disagreed on whether or not #11 can be veneered. Dr. H called the idea "laughable" because it is the abutmt for the bridge. (A "Dr S" suggested veneer or recrown, that those were the only options. A "Dr E" said no veneers for me). Again, who to believe???
<<I do understand we r in cyberspace + your help is therefore limited w/a complex issue. I have prev been to the IAOMT site + found little real help there other than 3 names. Any receptionist feels their DDS is great.>> THE IAOMT SITE IS LACKING ALOT OF HELPFUL GUIDANCE, I AGREE WITH YOU. THE REASON FOR THAT IS BECAUSE THE BIG DENTAL ORGANIZATIONS WOULD TRY TO SHUT THEM DOWN IF THEY WENT AGAINST THE TIDE TOO MUCH....... POLITICAL NONSENSE COMPLETELY. IT IS TRUE THAT MOST RECEPTIONISTS WILL TELL A CALLER THAT THEIR DOCTOR IS THE BEST..... WHEN IN REALITY THEY KNOW LITTLE TO NOTHING ABOUT HIS TOOTH CARPENTRY SKILLS!! AGAIN, HOW DOES THAT GET CHANGED..... I WISH I KNEW!
<<Perhaps I don't know the correct Qs to ask. Can U help there? Since all the DDSs I have been to ALL have diff opinions I don't know whom to trust or turn to.>> YOU ARE IN A SITUATION WHERE YOU HAVE TO FIND SOMEONE TO TRUST. THE ONLY THING I CAN TELL YOU IS TO ASK FOR ALL OF YOUR OPTIONS. MAKE YOURSELF CLEAR IN THAT YOU PREFER THE LEAST INVASIVE MEANS POSSIBLE. ANY NEW DENTIST IS GOING TO BE ABLE TO SEE WHAT YOUR DENTAL PROBLEMS ARE WITHOUT YOU REHASHING ALL THAT YOU HAVE BEEN THROUGH. I WOULD BE VERY PRECISE AND TO THE POINT..... AN EXAMPLE.... I'VE HAD X NUMBER OF GINGIVECTOMIES ON TEETH 3'S X,X,X. BONE REDUCTION ON TEETH #'S X,X,X. THIS IS MY # SET OF CROWNS WHICH INCLUDE PROVISIONALS. I AM TRYING TO ACHIEVE XXX.
***GREAT ADVICE!
<<Any further suggestions you can offer re the above crown reduction Q + finding a DDS qualified to handle such a complex issue are greatly appreciated.>> WHEN PATIENTS LIKE YOURSELF COME INTO AN OFFICE AS A NEW PATIENT, THEY HAVE ALOT TO TELL THE NEW GUY AND UNFORTUNATELY, THE DENTIST GETS HUNG UP IN THE "STORY" AND "DRAMA" OF THE SITUATION. THEY BECOME RELUCTANT TO DEAL WITH PEOPLE WHO COME IN WITH BAGGAGE BECAUSE THEY ARE AFRAID THEY WILL BECOME A PIECE OF THE LUGGAGE. THIS IS NOT MEANT TO SAY THAT YOUR BAGGAGE ISN'T REAL BECAUSE IT IS MOST DEFINITELY!! HOWEVER, TRY TO LEAVE ALOT OF IT BEHIND AND STICK TO THE PRESENT SITUATION SO THE NEW GUY CAN FOCUS ON YOUR DENTAL PROBLEM AND NOT YOUR BAGGAGE PROBLEM. DOES THAT MAKE SENSE TO YOU? I'M TELLING YOU THIS FROM LOOKING AT PATIENTS FROM THE OTHER SIDE OF THE CHAIR..... OK??
***Again, GREAT ADVICE!
By the way, I'm curious...what does the "other side of the chair" mean? Are you a DDS, tech...?
Where to look for a qualified dentist? Oh I really wish I knew! Word of mouth, family, your doctor's office??
***Apparently I lost that part of the reply when trying prev and had to redo the response...I've tried the 2 fmr w/ little success (Drs E and R were examples). My MD rec Dr G; and his prev unrelated cyst removals were w/exc results; however his perio skills are not his strong suit.
***For what it's worth, those cysts were in the #9 and in-bt 10-11 areas! #9 was perhaps 6 yrs ago. #10-11 was 2006 wherein Dr R missed what I adv him I tho't was a cyst...he did an unnec RTC on #11 instead for a non-existent abcess. Unfortunately I gave him the benefit of the doubt then for 1 mistake. Dr. G then removed what was in fact a cyst there.
***Yes, more complications in my health.
Please keep in touch............... I wish you all the best!!!!!!
***I have found what may or may not be a common thread in reported "good" DDSs. They seem not to accept insurance at all. Have you found that tb true?
Dr. T does not because they restrict his TXs, labs, etc. Any coverage consideration is out of netwk, etc.
***(I even find myself listening to the counter help @ Wendys, I'm so lost! Her DDS does not accept ins either.)
***Dr T's office is closed Fridays. I w/take the wkend to decide whether to see him next week. I STRONGLY feel as you do, that re-doing all this work is too traumatic both physically and emotionally!!!
***However, if PFM material is going to irritate my tissue, I may have to reconsider and pay the 3rd time for this work which is becoming a MAJOR EXPENSE in every way. Giving what you said abt non-metal materials, what do you think?
***Trying to follow my instincts at this point is viritually impossible. My mind is mush.
Therefore, any further tho'ts you have given the current events are more than WELCOME!
***THANKS!
NAM
Bryanna
I hate to give up just (or esp) because I'm diabetic.
Thanks!
NAM